Availability of short-term health insurance in Pennsylvania

Yes. As of 2024, there were at least two insurers offering short-term health insurance in Pennsylvania.

Pennsylvania does not have its own regulations pertaining to the length of time that a short-term health insurance policy can remain in force, so the state defaults to the federal guidelines.

Trump administration rules for short-term plans that took effect in 2018, allowed for initial terms of up to 364 days and total duration, including renewal, of up to 36 months. However, in 2024, the Biden administration finalized new rules for short-term health plans. Short-term plans issued or sold on or after Sept. 1, 2024 are limited to total durations of no more than four months, including renewals. Initial terms will be capped at no more than three months

Short-term health insurance in Pennsylvania is available to residents (individuals or families) who meet insurers’ underwriting guidelines.

To be eligible for short-term health insurance, an applicant generally needs to be under age 65 and not have any of the medical conditions that would cause the application to be declined. ¹ But the specific requirements vary from one insurance company to another.

Short-term health medical insurance plans typically do not cover pre-existing conditions, and they often use post-claims underwriting (meaning that they may go back through a person’s medical records after a claim is filed, to make sure it isn’t related to a pre-existing medical condition). ²

Short-term health plans are not required to cover the ACA’s essential health benefits; they often do not include coverage for maternity care, prescription drugs, or mental health care.¹ For the coverage they do provide, they generally impose dollar limits on the amount they will pay. It’s important to double-check all of the plan information before purchasing a short-term policy, to make sure that you understand the limitations of the plan.

If you’re in need of health insurance coverage in the Keystone State outside of the annual open enrollment period (November 1 to January 15), your first step should be to see whether you’re eligible for a special enrollment period that would allow you to enroll in an ACA-compliant major medical plan. There are a variety of qualifying life events that will trigger a special enrollment period and allow you to buy a plan through the health insurance exchange in Pennsylvania (known as Pennie).

ACA plans are purchased on a month-to-month basis, so an eligible individual can enroll (with a premium subsidy if eligible) even if coverage is only needed for a few months before another policy takes effect.

Excluding coverage for pre-existing conditions can make short-term policies appear more affordable than ACA-compliant (Obamacare) policies. However, that upfront affordability disappears if you end up paying out of pocket for healthcare services related to an uncovered condition. That said, there may be situations when enrolling in a short-term plan might be an option, such as:

• If you missed open enrollment for ACA-compliant coverage and do not have a qualifying life event that would trigger a special enrollment period.
• If you are newly employed and have a waiting period until you can be covered by your new employer’s health insurance plan; short-term insurance is typically a much more affordable (but less comprehensive) stopgap than COBRA or an ACA-compliant plan.
• If you will soon be eligible for Medicare and just need a few months of coverage to bridge the gap (note that you may then be subject to a pre-existing condition waiting period if you enroll in a Medigap plan, as your prior short-term plan might not be considered creditable coverage by the Medigap insurer).
• If you’re not eligible for Medicaid or a premium subsidy in the exchange, an ACA-compliant plan might be unaffordable.

An insurance agent or broker can provide information on the availability of various coverage options and help you evaluate the affordability of those options. Some things to keep in mind are the allowable plan durations, whether the insurer offers guaranteed renewability, and the specific benefits the plan covers.

Pay attention to things such as whether the plan covers outpatient prescription drugs (most short-term health insurance plans do not, but some do), and whether it imposes specific dollar limitations on any specific type of service (such as inpatient care, surgery, etc.) and the overall policy benefit maximum.

Although short-term health insurance in Pennsylvania is allowed to follow the current federal regulations, its important for consumers to remember that short-term plans are not considered minimum essential coverage under the Affordable Care Act, and do not cover things like pre-existing conditions, and that the termination of a short-term plan will not grant a person a special enrollment period for ACA-compliant coverage.

HB695 introduced in Pennsylvania’s House of Representatives in February 2021, would have imposed strict limits on short-term health plans in the state if it had passed. (The bill was previously introduced as HB2730 in July 2020, but also failed to advance in the 2020 legislative session).